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Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart
Chiwon Ahn1, Yeonkyung Park2,3, Yoonseok Oh4
1Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Background:
Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.
Methods:
A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables.
Results:
In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001).
Conclusions:
Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.
Insights
Early bronchoscopy for pneumonia in the intensive care unit (ICU) did not lower 28-day mortality. This intervention was linked to longer ICU and hospital stays, indicating its use in more severe pneumonia cases.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Medical Informatics
Background:
- Pneumonia is a leading cause of intensive care unit (ICU) admission with significant mortality.
- Early intervention strategies for pneumonia in the ICU are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of early bronchoscopy (within 3 days of ICU admission) on 28-day mortality in pneumonia patients.
- To analyze the association between early bronchoscopy and patient outcomes, including length of stay and discharge disposition.
Main Methods:
- Retrospective analysis of 8,916 adult patients with pneumonia admitted to the ICU, using the MIMIC-IV database (2008-2019).
- Patients were divided into two groups: those who underwent early bronchoscopy and those who did not.
- Propensity score matching was employed to control for confounding variables and ensure cohort comparability.
Main Results:
- No significant difference in 28-day mortality was observed between patients who received early bronchoscopy (22.7%) and those who did not (24.0%) (P=0.589).
- Early bronchoscopy was associated with significantly prolonged ICU stays (P<0.001) and hospital stays (P<0.001).
- Patients undergoing early bronchoscopy were less likely to be discharged to their homes (P<0.001).
Conclusions:
- Early bronchoscopy in severe pneumonia patients admitted to the ICU does not reduce mortality.
- The procedure is associated with extended hospital and ICU lengths of stay, suggesting its application in more critically ill patients.
- Individualized patient assessment is essential when considering bronchoscopy, weighing potential benefits against associated risks.
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